Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Site index adjustments for old-growth stands based on veteran trees

Regional studies are supporting foresters’ perceptions that the site indices of British Columbia’s old-growth stands are being underestimated. A province- wide paired-plot study resulted in old-growth site index adjustments for coastal Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco var. menziesii), interior spruce (Picea glauca (Moench.) Voss, P. engelmannii (Parry) Engelm., and P. glauca x P. engelmannii), and interior lodgepole pine (Pinus contorta var. latifolia Dougl.). The objective of this study is to develop adjustments for species not covered in the provincial project. Adjustments for the species in the provincial project are also derived for comparison purposes. The data for this study come from temporary and permanent sample plots with a veteran and a main stand component. The site indices for the two components were estimated and an adjustment equation for each species was derived using the two site indices in a linear regression analysis. The veteran component represents an old-growth stand and the main stand component represents a managed stand. The analysis showed that the veteran site indices were being underestimated. Some guidelines on the application of these adjustments to old-growth site indices are provided